Health and Social Care

Charles Walker Excerpts

Thursday 16th January 2020 Commons Chamber

[Matt Hancock]

Absolutely. I am glad that we resolved the problems with the Countess of Chester Hospital serving patients who live in north Wales. I know that part of the world well, not least because I was born in the Countess of Chester Hospital and, for the first 18 years of my life, lived but a mile from my hon. Friend’s beautiful Wrexham constituency—I travelled through it every day on my way to school—so I know these cross-border issues intimately. It is ridiculous that we reached a position where the Countess of Chester Hospital was unable to take patients from north Wales because the Welsh NHS was unwilling to pay the relevant costs. We reached a good compromise, and we must ensure that it keeps working so that the problem does not happen again.

I will turn briefly to the fifth and sixth measures, Mr Deputy Speaker, which are very important. The fifth measure is mental health reform. Throughout the entire history of healthcare, mental health has been seen, treated and organised on a different basis from physical health. That is wrong. Over my generation the attitude that society takes towards mental health has fundamentally shifted. We are not there yet, but our mental health and physical health must be seen on an equal footing, and mental health must be treated as seriously as physical health.

As Health Secretary, I have made mental health a priority. Within the £33.9 billion of additional funding, mental health funding is increasing the fastest. We have a plan to improve mental health services across the nation. Just this week we opened a new gambling addiction clinic in Sunderland, and we will have 13 more across the country, in recognition of the unmet demand in our society. I fully support Claire Murdoch, the NHS mental health director, in her call today for gambling firms to act responsibly and prevent the loss of life.

We are making progress in how we treat all forms of mental ill health, but the legislation for mental health was written for a previous generation and we must bring it into the 21st century. The Mental Health Act 1983 is nearly 40 years old, and some of our legislation is still shaped by 19th-century views of mental illness. It is badly in need of modernisation. It is paramount that we ensure that people have greater control over their treatment, and that everyone receives the dignity and respect they deserve. We must get the legislation right. I pay tribute to Sir Simon Wessely for the work that he has done to set the parameters. We will publish a White Paper within months and then bring forward a new mental health Bill.

I want to say a word about the law governing the care of people with autism and learning disabilities, which concerns some of the most vulnerable people in our society. Again, parts of the law are antiquated. We are looking at this alongside the work on the Mental Health Act to ensure that the systems are appropriate and co-ordinated.

These are the six health and social care measures in the Queen’s Speech. It is central to this Government’s priorities that we meet the public’s expectations and deliver on our commitments. This Conservative Government made clear and solemn commitments in our manifesto. People in their millions placed their trust in us, many for the first time. People have entrusted us with the future of the NHS, and we will deliver on that trust.

[Sir Charles Walker (Broxbourne) (Con)]

Will my right hon. Friend give way just before he finishes his speech, because he is such a good egg?

[Matt Hancock]

I do not know how my hon. Friend knew that I was about to finish.

[Sir Charles Walker]

I thank my right hon. Friend for giving way, and I am sorry for arriving late in the Chamber, Mr Deputy Speaker. First, I thank my right hon. Friend for his action on mental health, which is fantastic news. Secondly, can we look at smoking cessation and public health? Smoking is simply an appalling thing to do. There are many products now on the market and we need to look at their efficacy, to see whether we can move people from smoking lit tobacco to a pathway to zero tobacco.

[Matt Hancock]

I want to see a pathway to zero tobacco too. I pay tribute to my hon. Friend for the work that he has done to draw attention to mental health and to change the national conversation about it, and indeed the global conversation.

We must meet each and every one of the commitments we made in our manifesto, because we are the party of the NHS, and that is the way it is going to stay.

Social Care Funding

Charles Walker Excerpts

Tuesday 1st October 2019 Westminster Hall

[Sir Charles Walker (in the Chair)]

Order. There are plenty of speakers, so we will have a time limit of four minutes, perhaps dropping to three as the debate develops.

[Sir Vince Cable (Twickenham) (LD)]

I beg to move,

That this House has considered social care funding.

I should like to introduce a discussion on the funding of social care and narrow that to adult social care and the specific areas covered in the admirable Library briefing around the Green Paper in its absence.

It is a relief to debate something that is not about Brexit, although there is probably some indirect connection. Attempts have been made to blame the delays on Brexit, but the Secretary of State was candid enough to acknowledge that deep-seated disagreements going back 20 years explain why we are at an impasse on the basic principles.

There are a couple of contradictions or paradoxes that we must try to unravel. We all say that the only way forward is to have an all-party consensus, but at the same time the issue is increasingly weaponised. We all say that this is an incredibly urgent problem, but it stays for longer and longer in the long grass. Until we get to the root of those problems, we are not going to make any headway.

--- Later in debate ---

[Several hon. Members rose—]

[Sir Charles Walker (in the Chair)]

Order. We have lots of people. I am going to start with a time limit of four minutes, but do not be surprised when I drop it to three.

--- Later in debate ---

[Several hon. Members rose—]

[Sir Charles Walker (in the Chair)]

Everybody is being so disciplined about interventions, which is great. Faisal Rashid, you, too, can have four minutes, but nobody else will.

[Faisal Rashid (Warrington South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Charles. Making sure that the sick and elderly are treated with care is the measure of any civilised society. I believe that we should not be judged by our personal wealth, but by our compassion for those in most need. Clearly, however, that ethos is not shared by our Government.

As we speak, 1.4 million older people are going without the care they need, which is totally unacceptable. We are faced with the huge challenge of meeting the increasingly complex care needs of an ageing population, yet as those needs have increased and intensified, state funding for those services has nosedived. Council budgets have been reduced by an average of nearly 50% since the Tories came to power. Those cuts have taken a staggering £7.7 billion out of social care funding since 2010.

In my constituency, Warrington Borough Council has had £137 million cut from its budget with another at least £22 million of savings to find by 2020. As a former new town, we are seeing a significant increase in our vulnerable older population—those who were drawn to Warrington for work and a better life in the 1970s and 1980s. Nationally, there are 8,000 fewer care home beds than in 2015, despite the kind of rising demand seen in my constituency. Reports indicate that, last year, almost 90 people a day died while waiting for care to be arranged for them at home. That is absolutely shameful. How can the Minister justify those figures?

The crisis in social care is felt by not just those in need of care, but their families and friends who must step in where the state has failed and where money is short. More than 5 million unpaid carers look after loved ones. Skills for Care has found an 8% vacancy rate in the social care sector, which is equal to 110,000 empty roles at any one time. Many who work in the social care sector are overworked and underpaid. Unison has documented at length the injustices faced by those who do such vital work: sleep-ins, impossible rotas, zero-hours contracts and unpaid travel time, to name just a few.

Make no mistake: this policy area is crippled by Government inaction and market failure, causing immense hardship and misery for those who need care and for those who provide it. It is high time our political leaders showed the courage necessary to rise to the challenge and fix this mess, ensured the safety and security of older generations and treated care workers with the respect they deserve. I am proud that my party has recently announced bold, radical plans to do just that.

Labour will introduce personal care free at the point of use in England funded through general taxation. Providing free personal care to older people will ensure that they will be able to live in their own homes for longer, providing them with dignity and the support to lead independent lives for as long as possible. I have seen at first hand from my mum, who passed away last year, how that is absolutely crucial.

[Sir Charles Walker (in the Chair)]

Speeches are now limited to three minutes.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (LD)]

I begin by paying tribute to all the family carers and the care workforce, including those who looked after my mother-in-law Mary. It was only with their support that she was able to die where she wished: at home, surrounded by her loved ones. That support is not available to everybody, but it should be. For the want of good social care, far too many people unnecessarily end up in far more expensive hospital settings. We must act quickly, and I hope that the Minister will update us on when the Government will come forward with their consultative social care Green Paper, because it was promised two and a half years ago. Five publication deadlines have been missed, so when will we see that Green Paper?

I also hope that the Minister will confirm that she has looked at the Joint Select Committee inquiry by the Health and Social Care Committee and the Housing, Communities and Local Government Committee, because the proposals provide a blueprint for how to move things forward. It contains practical suggestions that have been road-tested for their acceptability through a citizens assembly. I hope that she will also confirm that the principles set out in the document will form part of the Green Paper.

I am afraid that I am going to disappoint my right hon. Friend the Member for Twickenham (Sir Vince Cable), who said that this debate provided an opportunity not to talk about Brexit, because Brexit poses a grave threat to a fragile sector. The Yellowhammer documents make it clear that smaller providers face going to the wall within two to three months and larger providers within four to six months. I hope that the Minister will be able to comment on what action will be taken to mitigate that.

The effects include not only the impact of an increase in inflation on a fragile sector, but the impact on the workforce. As the Minister knows, the vacancy rate is already at 8%, which amounts to around 110,000 positions across social care. Some 8% of the workforce come from our partner EU27 nations, and many workers are deciding that it is no longer economically viable for them to remain in the UK due to changes in the exchange rate. Several careworkers have told me in tears that they no longer feel welcome in this country, which is horrific and should make us all feel a sense of great shame, but that is the reality. People face racist remarks in our country today despite decades of service to the most vulnerable in society. We cannot afford to lose them. We need to set out what will happen to ensure that the people in this workforce, many of whom will not meet the income thresholds, will be able to come here, share their skills with us and be welcomed.

[Sir Charles Walker (in the Chair)]

Thank you, colleagues. We now move to the Front-Bench speeches.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Sir Charles. I am grateful to the right hon. Member for Twickenham (Sir Vince Cable) for securing what has been a well attended and thoughtful debate.

The Office for Budget Responsibility assessed the UK’s public finances as potentially £30 billion worse off each year in a no-deal Brexit scenario of medium disruptiveness. That sum is significant because it is more than the entire sum spent on adult social care, plus investment in NHS buildings and equipment, across the United Kingdom in 2017-18. Much of the responsibility for social care is, of course, devolved, with respect to Scotland. The Scottish National party Scottish Government are currently working with a range of partners to take forward a national programme to support local reform of adult social care support. Scotland continues to be the only country in the UK that delivers free personal care. That currently benefits more than 77,000 older and disabled people in Scotland.

In England since 2010 the number of people receiving publicly funded social care has decreased by 600,000, because of funding cuts. In 2019-20 the SNP Scottish Government are increasing their package of investment and social care support and integration to exceed £700 million, up from £550 million in the previous year. In England a boundary has always existed between the NHS and social care, contributing to fragmented and unco-ordinated care. In Scotland the SNP Scottish Government successfully integrated health and social care, which is the most significant change to health and social care since the creation of the NHS in 1948. Last month the First Minister announced that everyone diagnosed with cancer will have a dedicated support worker, provided through a new £18 million partnership fund.

Of course, the devolved Administrations do not operate in isolation. Policy decisions from Westminster continue to have an impact on social care. The independent expert advisory group in Scotland deems that changes set out in the UK Government’s immigration White Paper would reduce net migration to Scotland by between 30% and 50% in the coming two decades. That is extremely significant. It states that social care would be severely affected as fewer than 10% of those in caring personal service occupations in Scotland earn above £25,000, and almost no one earns over the £30,000 immigration threshold. Average earnings of adult social care workers are higher in Scotland than they are elsewhere in the UK, coming in at about £18,400 as opposed to £17,300. Yet people are thinking about a £30,000 immigration limit. Just let those figures sink in. Thanks to Scottish Government funding, staff can be paid at least the real living wage, but it is still nowhere near the immigration threshold. That is a serious worry in respect of future provision throughout the UK, not just Scotland.

The number of Scots over 80 with social care needs is set to increase by 68% by 2036. That is probably an even faster rate than the English figures that we have heard from some hon. Members. My hon. Friend the Member for Argyll and Bute (Brendan O'Hara) called for an independent evaluation of the impact of Brexit on the health and social care sector, through his private Member’s Bill, the European Union Withdrawal (Evaluation of Effects on Health and Social Care Sectors) Bill. The Bill was supported across the House and by 102 organisations, but I wonder whether the UK Government are listening.

On 18 August The Sunday Times, citing UK Government planning assumptions under Yellowhammer, stated:

“An already ‘fragile’ social care system is expected to be tipped over the edge by a no-deal, with providers starting to go bust by the new year”.

The report quoted the document as saying that “smaller providers” would be

“impacted within two-three months and large providers four-six months”

after Brexit. The negative economic impact of a disorderly Brexit, including an increase in inflation and an economic recession, will augment the pressure on providers and will shift the burden of care work on to unpaid family carers, the majority of whom are women. I look forward to hearing the Minister address those points, particularly on the issue of migrant staff and the £30,000 immigration limit.

[Sir Charles Walker (in the Chair)]

I want to give Sir Vince Cable two minutes at the end, so if the other Front-Bench colleagues could maintain a 12-minute discipline, or just under, that would be great.

--- Later in debate ---

[Sir Charles Walker (in the Chair)]

Thank you. Minister, if you could leave two minutes at the end for Sir Vincent Cable to wind up the debate, that would be hugely appreciated.

--- Later in debate ---

[Sir Vince Cable]

Sir Charles, thank you for safeguarding the last 10 minutes. I tried to approach this whole subject in a non-tribal way. I thank all the Members, including the Minister, who participated in that spirit. The debate was enriched by people drawing on professional experience, such as the hon. Member for Lincoln (Karen Lee), and those drawing powerfully on personal case experience, such as the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard), the hon. Member for York Central (Rachael Maskell), the hon. Member for Eastbourne (Stephen Lloyd), the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) and others.

The title of this debate included the ugly word, “funding”. However good our intentions, we do have to pay for this, and I commend the hon. Member for Thirsk and Malton (Kevin Hollinrake) for setting out clearly and succinctly the financial constraints and a good solution through social insurance for many of these problems. I also commend the hon. Member for Sefton Central (Bill Esterson) and the hon. Member for Newton Abbot (Anne Marie Morris) for pointing out that we are trying to reconcile two fundamentally different systems of funding and organisation. As we integrate the system, bringing them together is not an easy task.

Perhaps I tried too hard to be non-tribal. I thought we were trying to get a bit of respite from Brexit. However, as my hon. Friend the Member for Totnes, the hon. Member for Linlithgow and East Falkirk (Martyn Day), and others pointed out, unfortunately we cannot get away from it. It has a major impact on resource availability and the labour market.

In conclusion, I wish to thank the Minister for her reply. She pointed out—and I should have acknowledged this at the beginning—that the Government have put in a little bit more in resource. However, that is growing at 2.5% while the demand is growing at 4% and the cruelty of compound interest is, I am afraid, rather powerful and painful over time.

[Sir Charles Walker (in the Chair)]

Colleagues, thank you for sharing out the time so well.

Question put and agreed to.

Resolved,

That this House has considered social care funding.

Heated Tobacco

Charles Walker Excerpts

Wednesday 26th June 2019 Westminster Hall

[Mr Jones]

I do indeed. I will also comment on my hon. Friend’s point about other people having to endure smokers’ smoke. One point that the Government make in their response to the Science and Technology Committee’s report is that heated cigarettes are far less offensive to other people than combustible cigarettes.

Consumers’ principal reason for using e-cigarettes is to give up smoking. According to Action on Smoking and Health, 62% of ex-smokers use e-cigarettes for that purpose, and the majority of users have successfully quit smoking. However, it might well be that we have now passed the apogee of the e-cigarette effect. According to the Office for National Statistics, the number of new e-cigarette users peaked at 800,000 in 2013-14. Since then, the number has approximately halved every year, down to 100,000 in 2016-17. It is not the case that the remaining smokers do not want to quit; the ONS reports that nearly 60% do. For some, however, the experience of using e-cigarettes does not come sufficiently close to that of smoking to be an adequate substitute. In this context, I urge the Government to consider the alternatives.

In Japan, heated tobacco is proving very successful in helping smokers to quit. Evidence there shows that 70% of heated tobacco users give up smoking altogether. That is a better conversion rate than for any other alternative nicotine-containing product on the market.

[Mr Charles Walker (Broxbourne) (Con)]

I have been a smoke-free person for 15 years, but it took me 12 years to get there. I had various failed attempts to give up smoking because it was a choice between smoking and chewing gum, which really was not a successful pathway—it took me 12 years before I could finally give up. Any method that helps the process has to be a good idea.

[Mr Jones]

I am very pleased to hear that. Of course, it is debatable whether chewing gum is more or less antisocial than smoking—particularly in its effect on pavements.

The heated cigarette process uses an electronic device that heats tobacco, producing an aerosol that tastes like tobacco, and it delivers nicotine in a similar way to a cigarette. Importantly, however, it is not a product of combustion. Tests on heated tobacco carried out by the tobacco industry and scrutinised by the Committees on Toxicity, Mutagenicity and Carcinogenicity of Chemicals in Food, Consumer Products and the Environment found a reduction of up to 90% in the number of toxic chemicals emitted by heated tobacco compared with combustible cigarettes. That is not greatly dissimilar to Public Health England’s finding that e-cigarettes are up to 95% safer than combustible cigarettes.

Heated tobacco is currently sold in the UK, but there is no independent research to validate its use. Members of Parliament have said that research is needed, and the Government have agreed. As I mentioned a few moments ago, the Science and Technology Committee’s July 2018 report highlighted the need for independent research. It identified the opportunity for the Government to

“help fill remaining gaps in the evidence on the relative risks of e-cigarettes and heat-not-burn products”

and support a long-term research campaign that would be overseen by Public Health England and the Committee on Toxicity to ensure that health-related evidence is not dependent solely on the tobacco industry.

The Government’s December 2018 response to the report was favourable. They accepted the recommendation and undertook to

“review and consider where there are gaps in evidence for further independent research”.

They went on to say that they are

“committed to providing the outputs of research to the public on the risks of e-cigarettes and novel tobacco products.”

They also committed to including heated tobacco in their annual review of e-cigarettes. However, this year’s e-cigarette review contained no mention of heated tobacco.

We are falling behind our international peers on this front. The United States Food and Drug Administration recently produced research that concluded that heated tobacco is

“appropriate for the protection of the public health because, among several key considerations, the products contain fewer or lower levels of some toxins than combustible cigarettes.”

It reported up to 95% lower quantities of certain toxins.

My question to the Minister is this: will the Government commit to producing or supervising independent research into heated tobacco this year? We are talking about a matter of personal choice for smokers, but the Government have a duty to inform them about the available alternatives. We have seen the value of e-cigarettes in helping people to quit smoking, and if there is a prospect that heated tobacco could help to bring down smoking rates further, are we serving the interests of public health by not carrying out the promised research? Might not an approach akin to the innovation principle, as opposed to the precautionary principle, ultimately lead to fewer smokers? If it might, should we not, like David Halpern, seize the opportunity?

The research will not happen by itself. The responsibility to produce it lies with the Government, as they have acknowledged. From 1 July, we will be acknowledging heated tobacco in the tax system. Is not now an appropriate time for the Department of Health and Social Care to ensure that the new tax category goes hand in hand with independent research on the efficacy of heated tobacco in bringing down smoking rates and its impact on public health? It may be suggested that the lack of funding is an issue, but I urge the Government to consider requiring tobacco companies to pay for the research to be carried out, thereby circumventing the need to apportion departmental budgets to it.

The reduction of harm from smoking must remain a top priority for this and any other Government. I therefore hope that the Minister will respond positively to my suggestion.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Mr Gray. I thank my right hon. Friend the Member for Clwyd West (Mr Jones) for raising the important issue of heated tobacco products and their contribution to reducing harm from smoking, and for his lifelong service as a fellow of Cancer Research UK. He put it very well: smoking is still prevalent in certain communities in our country, and still causes over 78,000 deaths a year in England. It is one of the leading causes of preventable illness and premature death. We have made great progress, particularly over the past 10 years. Adult smoking prevalence is now 14.9%—the lowest ever recorded level—but, as he pointed out, we have much further to go, particularly among certain groups and in certain parts of the country.

In the 2017 tobacco control plan, we set out our ambition to reduce smoking and ensure a smoke-free generation. Part of that strategy is about helping people to stop smoking by adopting the use of less harmful nicotine products. They may, for example, take up chewing gum. I have never seen my hon. Friend the Member for Broxbourne (Mr Walker) spit out his gum on the pavement.

[Mr Charles Walker]

I quit 15 years ago, but it took me 12 years because the only choice besides smoking was nicotine gum, and it was simply revolting. I would have quit a lot earlier if we had some of these modern products around 15 years ago.

[Seema Kennedy]

I hear what my hon. Friend is saying. For a lot of people, nicotine substitutes are a good transition to giving up smoking or other things completely. We have seen a dramatic rise in the use of e-cigarettes from 1.6 million users in 2014 to about 2.5 million in 2017. Encouragingly, about half of them in England have quit smoking completely. E-cigarettes are not risk-free, however. The evidence is increasingly clear that they are significantly less harmful to health than smoking tobacco. They can help smokers to quit, particularly when combined with stop smoking services. Recent studies have shown they can be twice as effective as nicotine replacement therapy in helping people quit smoking. As my right hon. Friend the Member for Clwyd West pointed out, the sales of e-cigarettes are plateauing, and we are coming to the stubborn 5% of people who are still smoking.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Charles Walker Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

[Dr Whitford]

The right hon. Gentleman probably would not like me to get into the clearances of the 17th and 18th centuries when people were burnt out of their villages and put on boats, or when people were transported for criminal activities. There are all sorts of reasons why Scots have ended up all over the world, and they are not all about the weather.

[Mr Charles Walker (Broxbourne) (Con)]

I just want to say to the hon. Lady that I adore Scotland. I just love the mist, the fog, the rain—it is what I call proper weather, and it is to be celebrated.

[Dr Whitford]

That is why I live there, right beside the sea, but that does not necessarily mean that somebody living in the vineyards of France will think, “You know what? The weather’s a bit boring here. I fancy somewhere with snow, sleet, hail and sunshine all in one day.”

It is a fact that the disparity is because of the number of pensioners. It is often described as if it is the EU somehow tricking the UK—it simply is not. We are obliged to pay for the pensioners from the UK who have settled in Europe. Indeed, we pay a fixed rate per head that is considerably lower than—just over half—what would be charged for a European citizen settling here.

Princess Alexandra Hospital, Harlow

Charles Walker Excerpts

Tuesday 5th June 2018 Commons Chamber

[Robert Halfon (Harlow) (Con)]

It is a pleasure to see you in the Chair, Madam Deputy Speaker. I thank you for your support for a new hospital in Harlow, as my constituency neighbour.

I want to update the House on the desperate need for a new hospital in Harlow that is fit for the 21st century. The hospital would bring together A&E services, GP provision, social care, physiotherapy and a new ambulance hub in state-of-the-art, purpose-built facilities. Success in securing the capital funding, for which there is already a bid in place, could make this a reality for Princess Alexandra staff and patients in Harlow and across the region.

When I debated Harlow’s hospital last October in Westminster Hall, it was in special measures. In March, following the Care Quality Commission inspection, we heard the amazing news that the Princess Alexandra had left special measures. In fact, two thirds of services were on their way to a good or an outstanding rating. I said it then and I will say it again: this is a testament to the extraordinary hard work of all Princess Alexandra Hospital staff, including the cleaners, porters, nurses, doctors, kitchen staff, support staff and, of course, the leadership and management. I would like to give a particular mention to Nancy Fontaine, head of nursing and one of the most remarkable NHS workers I have ever met. Nancy will soon be leaving the Princess Alexandra to help another hospital, but I take this opportunity to thank her for her work. It is people like her who make the NHS what it is.

The Health Secretary congratulated PAH staff in a video—a sentiment seconded by the Prime Minister. In his message, the Health Secretary not only noted the impressive CQC report and the outstanding work in the neonatal department, but made it clear that it is the staff who make a hospital and that good care is the result of their instinct to do the right thing for patients. The Health Secretary and the former Hospitals Minister, my hon. Friend the Member for Ludlow (Mr Dunne), have both visited the Princess Alexandra a number of times, speaking to the staff and the leadership there. I know that the Health Secretary and the current Hospitals Minister—to whom I am hugely grateful for engaging with me regularly on this issue—are aware of the capital funding bid in place.

The leadership team, headed by chief executive Lance McCarthy, have been developing their case for capital funding since the Health Secretary made the request in autumn 2016. The team are due to resubmit the final plans next month. I understand that the trust is one of seven schemes requiring more than £100 million of capital and that funding for some schemes will be announced in the autumn. I ask the Minister, when will we learn of the progress of these capital funding bids?

[Mr Charles Walker (Broxbourne) (Con)]

Does my right hon. Friend agree that Princess Alexandra Hospital has a great future if it is allowed to have that future?

 Orkambi and Cystic Fibrosis

Charles Walker Excerpts

Monday 19th March 2018 Westminster Hall

[Paul Scully]

I understand the hon. Gentleman’s position and concern, especially so when many people in Ireland in particular are cystic fibrosis sufferers, but I remind him that NHS England is the procurer, not the Government—it is done through that independent process.

[Mr Charles Walker (Broxbourne) (Con)]

I discussed this with my hon. Friend the Member for Meon Valley (George Hollingbery), who is in the Chamber. We decided that it is essential for Vertex and NHS England to be reasonable. There is common ground and a deal to be done. Both sides need to work towards that with the encouragement of the Minister and the Department of Health and Social Care.

Oral Answers to Questions

Charles Walker Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

The right hon. Lady is absolutely right. We have looked into this and realised that there are two issues when it comes to improving children’s and young people’s mental health. The first is improving access to specialist care for those who need it. The other is prevention: the work that can be done by teachers within schools and in training people in mental health first aid. Those kinds of things can make a huge difference and we want to make sure we do them both.

[Mr Charles Walker (Broxbourne) (Con)]

I welcome the Secretary of State’s focus on child and adolescent mental healthcare, but what is he going to do about out-of-area transfers, which too often mean that children are found beds 200 or 300 miles away from their home? That is not in anyone’s interest, and it certainly is not in a child’s interest to be that far away from their support network.

[Mr Hunt]

I thank my hon. Friend for his continuing campaign on mental health issues. He is right to say that this situation is completely unacceptable, not least because if we want a child to get better quickly, the more visits from friends and family they can have, the better it is and the faster their recuperation is likely to be. We have commissioned 56 more beds, so the total number of beds commissioned for children is at a record 1,442, but we are determined to end out-of-area treatments by the end of this Parliament.

North Middlesex University Hospital NHS Trust

Charles Walker Excerpts

Tuesday 12th July 2016 Westminster Hall

[Ben Gummer]

I reassure the right hon. Gentleman that NHS England has a live rota stream from the hospital to give it the reassurance that every single junior doctor has a consultant supervisor in place at all times—precisely to ensure that the reported lapses of supervision do not recur. When the right hon. Gentleman meets the chief inspector at the CQC tomorrow, I hope that he hears something similar to what I have heard: things are not good, but they are better than they were, and the trajectory is in the right direction.

Nevertheless, we will not fix this without looking at fundamental reform of local health services, which requires changes to primary care, of the kind that we discussed when I met local Members of Parliament last week. I hope to meet them again, in a few weeks or months, and to be able to talk about progress and the plans for the future, so that right hon. and hon. Members will be satisfied that things are getting better at the North Middlesex.

[Mr Charles Walker (in the Chair)]

I thank the Minister—my constituents in Broxbourne will be following the outcome of this debate closely.

Question put and agreed to.

Resolved,

That this House has considered the performance of North Middlesex University Hospital NHS Trust.

Deaths in Mental Health Settings

Charles Walker Excerpts

Friday 27th February 2015 Commons Chamber

[Mr Charles Walker (Broxbourne) (Con)]

I rise to congratulate Deborah Coles and INQUEST on publishing an extremely important document entitled “Deaths in Mental Health Detention: an Investigation framework fit for purpose?”. INQUEST’s report focuses on the deaths of those detained under the Mental Health Act 1983. There are two sad truths. First, too many people are dying in mental health detention—on average more than 300 people a year in each year between 2003 and 2013. Secondly, there is no mechanism for independent investigation of those deaths.

Mental health patients have an absolute right to life, and that right must not be forgotten, abused or cast aside. That absolute right to life extends to the state having a positive duty to safeguard those patients from taking their own life. When there is a death in custody, the police have the Independent Police Complaints Commission to investigate it. The Prison Service has the prisons and probation ombudsman to investigate, but the NHS has nothing that could be classed as independent.

The Coroners and Justice Act 2009 clearly states that deaths in mental health detention that are “violent or unnatural” or cases in which

“the cause of death is unknown”

should be scrutinised at inquests before a coroner sitting with a jury. However, in almost all cases in the NHS, the relevant trust or care provider is the investigating agency, so we have the NHS investigating itself when someone dies while in its care. There are many problems with that.

One of the main problems is that coroners are reliant on the reports provided by the NHS body that is investigating itself when someone dies in its care. Also, families are too often excluded from the investigation processes conducted by NHS trusts, and the length of time that an inquest can take is enormously variable. Some can be done very quickly, resulting in families feeling railroaded; others can take years. One anomaly that needs to be addressed is that any inquest that takes a year and a half or more is deemed to have taken a year and a half. So an inquest can wait to be heard for five years, yet for the purpose of statistics it has been waiting for only a year and a half—that is unacceptable.

As I have said in this place on numerous occasions, there is inequality in representation: the agents of the state are represented by QCs funded by the taxpayer, whereas the families are pretty much left to their own financial devices. I shall return to that issue later. There is also a desperately poor collation of statistics on the type, number, frequency and features of these deaths—there is no transparency. INQUEST observes in its report that its

“experience is that the practice of NHS Trusts in investigating these deaths, and the issues raised by them, is consistently falling short of the existing guidance”.

INQUEST reports that over the past five years it has been unable to identify a single independent investigation at the evidence-gathering stage following a self-inflicted death.

INQUEST goes on to cite the following deficiencies in the process: a lack of family liaison with trusts following a death; families not being provided with any information about the investigation process or informed of their right to be involved in that process; no information being provided to families as to where they can find independent advice and support; families having little, if any, opportunity to raise concerns or questions; families not being provided with the terms of reference of an investigation; trusts refusing to provide families with the final versions of reports; and trusts failing to pass on a copy of the final report to the coroner. This situation is absolutely devastating for families and its impact on their morale cannot be overstated. It is wrong and something needs to be done. Sadly, the list I have read out is incomplete, but time prevents me from adding further points.

More generally, the superficial nature of investigations and the speed at which some cases move to the inquest hearing stage leave many families without any meaningful chance of establishing the circumstances of their relative’s death and, crucially, whether the death was preventable. As I said a few moments ago, there is another option for trusts keen to avoid their responsibility or owning up to their responsibility. One option is to push the investigation through extremely quickly, railroading people, but the other option is to drag its feet. As I said, an investigation that took five or six years to complete would still be deemed to have taken a year and a half when the coroner’s court reported. That is unacceptable.

Why is robust investigation so important? It is because our coroners generally rely on other agencies to gather relevant evidence before an inquest hearing, and have limited resources and powers to direct any initial investigations. So a coroner’s court will only be as good as the evidence provided to it. Therefore, it is currently the case that the rigour and thoroughness of inquests into deaths in mental health detention are ultimately dependent on the internal hospital investigation—the NHS investigating itself. The shortcomings in the current process mean that highly relevant evidence is often not identified, gathered and preserved, or, even worse, that the evidence-gathering process is influenced by those who have both control of the material and an interest in the outcome. INQUEST states:

“This incomplete or tainted evidence then flows through the inquest system and is effectively ‘fruit of the poisonous tree’”.

So if we are to continue with the current discredited system—I hope we are not—at the very least NHS trusts and health care providers need clear guidance, not just on the form of their investigations, but on who is responsible for undertaking them. Ultimately, what we need is the independent investigation of deaths, along the lines of the investigations undertaken by the Independent Police Complaints Commission and the prisons and probation ombudsman. We need an independent investigation that involves the families of the deceased, which, at its conclusion, produces a rigorous investigation report that is published and made widely available. That and only that will allow for robust inquests that get to the truth.

At these inquests there must be equality of representation. As I said earlier, it is simply not acceptable for the agents of the state to be represented by QCs funded by the taxpayer, while the families of the deceased are means-tested to see what they can afford. Quite simply, if someone is in the care of the state, the state has a duty of care.

If we are to have the proper investigation of deaths in mental health settings, we need greater investigatory independence matched to a coherent data set on the number of deaths in mental health settings. These data should record age, gender, ethnicity, the location of the death and the type of death—for example, whether it was self-inflicted, restraint-related or from natural causes. As death rates by individual units or clinical commissioning groups are not published, the statistics currently available in the public domain do not enable identification and analysis of where deaths in mental health settings take place. Again, this lack of transparency must be addressed.

The lack of publicly available data is particularly concerning in relation to ethnicity, where there are significant concerns about the continued over-representation of black people in mental health settings and the coercive use of force that features in some of their deaths. I would like to take this opportunity to briefly congratulate and thank Matilda MacAttram of Black Mental Health UK on her fantastic campaigning in this important area. I see that the Policing Minister is on the Front Bench; I am sure that he will pass on his congratulations to Matilda as well.

[The Minister for Policing, Criminal Justice and Victims (Mike Penning)]

indicated assent.

[Mr Walker]

Perhaps most worryingly, it is difficult, if not impossible, to identify from the current statistics the number of children who have died in mental health settings. This is simply not good enough. Children are detained in mental health settings and sadly, on occasions, some of those children are dying while being detained. We really need to minimise that occurrence as a matter of utter urgency.

The Minister replying to this debate will know that deaths in custody—or, more accurately, deaths while in the care of the state—is the topic of much debate at the moment, with the Equality and Human Rights Commission publishing its paper and concerns earlier this week. That paper was launched in the House of Commons. There is growing concern, and it is clear that there is a demand from many quarters, across the United Kingdom—people with a stake in this issue—for decisive action to be taken. Although for the past 10 years the overall trend has been downwards, deaths in mental health settings still account for 60% of all deaths in state custody.

More than half the deaths in mental health settings are ascribed to natural causes, but this in itself is a cause of concern, because the descriptor “natural causes” may mask deaths where contributing factors include the side effects of high-dose, multiple medication on the individual’s physical health. There is too much uncertainty hidden under the heading of “natural causes”, and it will stay that way until in-house investigators are replaced by independent investigators and independent oversight; because in an ideal world, where there is a violent death —a death that involves suicide, the use of force or restraint—the default position should be for an independent investigation. In cases where natural causes are suspected, an independent body could review the initial findings of the NHS trust before accepting them or asking for more information, with a view to mounting a formal investigation.

Seeing that the Policing Minister is here, I cannot let this occasion pass without saying that there is still widespread concern that on too many occasions police officers are being called to mental health wards—NHS environments—to restrain patients. Police officers are not trained to do that. I know this is causing the Minister concern; I know it is causing police officers concern. It should cause us all concern.

In conclusion, there is much work to be done to ensure that where a tragedy does occur in a detained mental health setting, there is a robust, independent system of investigation that gets to the truth, provides both closure and reassurance to grieving families and, through initiating changes in existing processes and procedures, prevents future deaths. I met some of the families last week who attended the launch of the INQUEST paper. It was a very sobering experience. These are good people who are seeking answers as to why husbands, wives—people they love—have lost their lives while in the care of the state. We need to be better at providing those answers.

--- Later in debate ---

[Jane Ellison]

Yes, he is wearing both hats today. He has confirmed that he will take this matter forward in the Ministry of Justice, and I am grateful to him for that. The fact that, in the last Adjournment debate of the parliamentary week, the two Departments most closely involved in responding adequately to these matters are represented by Ministers shows how important they are.

My hon. Friend the Member for Broxbourne might wish to raise his concerns about the robustness of inquests directly with the Office of the Chief Coroner. However, let me tell the House about another way in which the better use of data is helping in this situation. I understand that the Care Quality Commission is undertaking analysis of the information available from coroners’ investigations and inquests, along with other information it already receives on expected and unexpected deaths, which should help it to target requests from coroners better.

The Care Quality Commission is also working with the Coroners Society of England and Wales and the Office of the Chief Coroner to establish a memorandum of understanding, with the aim of achieving better working relationships and sharing of information. I am sure that my hon. Friend, having had the chance to highlight the importance of this issue today, will want regularly to ask questions, presumably in the next Parliament, about how this work is progressing and what the timetable is. Indeed, the Minister for Policing, Criminal Justice and Victims has heard his request for vigour and energy behind that work.

In conclusion, it is absolutely right that we should seriously consider how to improve the investigation of deaths in mental health settings.

[Mr Charles Walker]

The reason independent investigation is so important is that people can be detained against their will under the Mental Health Act 1983. There needs to be some oversight of their welfare, and they need to be safeguarded, but it is difficult if that is provided only by the NHS, the organisation that is responsible for detaining them. That is why independent oversight and safeguarding is needed.

[Jane Ellison]

I absolutely understand that point, which my hon. Friend has made with some power. I certainly undertake to speak with my colleague the Minister of State, the right hon. Member for North Norfolk (Norman Lamb), who leads on mental health matters in the Department, and ensure that he is aware of my hon. Friend’s strength of feeling about the issue. I will refer him to the Hansard report of this debate. I am sure that my hon. Friend will continue to press the case. I hope that the issues I have touched on in my response give him some sense that work is in train to look at this. The seriousness of the issue is very much acknowledged in both the Department of Health and the Ministry of Justice.

It is important that we set out clear requirements for rigorous, transparent and timely investigations of serious incidents, including deaths, and for all those affected, including the families, to be involved throughout those investigations. We must continue to seek to improve the overall process of learning from deaths to prevent further avoidable tragedies. The Department of Health, NHS England and the CQC continue to look at ways of improving the system, along with colleagues in other Departments, particularly in relation to transparency and ensuring that lessons are learned. I congratulate my hon. Friend once again on bringing these important matters to the attention of the House.

Question put and agreed to.

Children and Families Bill

Charles Walker Excerpts

Monday 10th February 2014 Commons Chamber

[Jane Ellison]

As I said in my earlier statement to the House, the Chantler review is looking specifically at the public health aspects of these matters. Sir Cyril is perfectly free to look at whatever he wants, but those are his terms of reference. Other issues will be considered in the round when Ministers come to make their decisions. Those issues were of course fully explored during the consultation that took place before the review.

The amendment sets out the elements of tobacco packaging that could be regulated—for example, the use of colour, branding or logos, the materials used and the texture, size and shape of the packaging. It also sets out the aspects of the tobacco product itself that could be regulated.

[Mr Charles Walker (Broxbourne) (Con)]

My hon. Friend will know that one of the main scourges for young people is alcohol. Why are the Government not proposing standardised packaging for alcohol?

[Jane Ellison]

My hon. Friend makes an interesting point, but that is probably a debate for another time.

The Government would not necessarily use all the powers I have just described, and if we proceed, we will need to decide which aspects would be included in any regulations. However, it is prudent to take a comprehensive approach now, so that we are prepared for the future.

--- Later in debate ---

[Jane Ellison]

I thank my hon. Friend for putting his view on record. I am sure that we will hear further views in the debate that follows.

[Mr Charles Walker]

Will the Minister give way?

[Jane Ellison]

I want to make a bit of progress because I sense that a lively debate will follow my speech, so I want to leave time for that.

The Government—and all Members—are clear that children should not be exposed to second-hand smoke, which can be particularly harmful to young children, and we know that young people often have little choice about being in places where they are exposed to smoke. Nevertheless, there are obviously many ways of trying to achieve that aim, which takes me on to the point about education raised by my hon. Friend the Member for Brighton, Kemptown (Simon Kirby).

We need smokers to protect children not only in the family car, but in any enclosed environment, including the home. Many argue that legislation is the answer, and we will debate that today, but social marketing campaigns to help smokers and parents to understand the risks of second-hand smoke and strongly to encourage voluntary behaviour change are also vital. We would all like to think that the vast majority of parents would not knowingly risk the health of their children. In the event that legislation is introduced to stop smoking in cars carrying children, we should measure its success not by the number of enforcement actions, but by the reduction in exposure to second-hand smoke.

As I have said, the Government will listen carefully to what Parliament has to say about the important principle of whether we should have the power to legislate to prevent smoking in cars when children are present. We will then consider what needs to happen next, which is why, if hon. Members will forgive me, I am not able to talk in great detail about some of the points that they have raised—they are questions for the next stage, once the will of Parliament has been expressed. However, in any event, I have asked Public Health England to continue its work on behaviour change in this area, including through social marketing campaigns. I have asked it to carry out targeted work with local authorities and public health directors in places where we know that there are problems. When Parliament’s will is known and we can assess the maximum impact that can be achieved through education, we will consider putting in place wider public information campaigns.

Arguments about effective enforcement were well rehearsed during the passage of this Bill and the consideration of private Members’ Bills on this matter, including that promoted by the hon. Member for Stockton North (Alex Cunningham). I look forward to hearing the debate on smoking in cars with children present and to finding out the will of the House on the principle of the Lords amendment. I also hope that the House will support our proposals on other aspects of tobacco control: the regulation-making powers on standardised packaging; and measures on the age of sale for electronic cigarettes and the proxy purchasing of tobacco.

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

Listening to this debate, I could have heard the same things said in 2006 when the House came to a decision on smoking in public places. That is public health legislation which the Prime Minister says is good legislation, although he did not vote for it at the time. I hope that Members will bear that in mind.

I hope that Members will also bear in mind, as we always must when considering such legislation, that currently in the UK over 100,000 people a year die prematurely from smoking tobacco. I support the amendment, which will, I hope, further restrict the use of tobacco not just by young people but, in turn, by adults. As the Minister said, two thirds of people who start smoking are young when they do so, and it is addictive.

One of my points relates to what the Minister said about e-cigarettes not being sold to people under the age of 18. Some people argue that e-cigarettes are a gateway to tobacco use, but the organisation that I have worked with on this over many years—Action on Smoking and Health, which the hon. Member for Shipley (Philip Davies) clearly admires—says that there is no firm evidence for that at this stage; it is doing another survey this year. The important thing is that over 2 million people are using e-cigarettes, some of them so that they smoke less tobacco and some so that they smoke no tobacco. I agree with the Minister that we should view them as a medicinal product—as part of the family of nicotine replacement therapies. That should be our approach in stopping these awful deaths from smoking. VAT on nicotine replacement therapy products is currently 5%. If e-cigarettes were also licensed and charged at the same rate, that would benefit everybody.

I support what the Minister said about proxy purchasing. This has not yet been addressed and it should have been. Alcohol and tobacco are harmful, depending on how they are used, although alcohol is not as bad as tobacco.

We have debated standardised packaging many times in the House and heard the arguments about printers being affected, and so on. The hon. Member for Shipley said that standardised packages are very complicated, and of course they are. I hope that we will have better safeguards to stop people engaging in contraband activities. There is no way that this measure will do anything other than stop people advertising on cigarette packets the products that cause all these premature deaths.

I support the Government and the Opposition on banning smoking in cars with children. Enforcement is always an issue, and we accept that. When I first started driving, people had to have seat belts in cars but did not have to wear them, and only one person in four did so. When the law was changed, 90% of people started wearing them practically overnight. This is about changing habits. We could not have a worse situation than somebody in a confined space like a car smoking cigarettes when children are there.

Everybody said that the ban on smoking in public places would never be enforced. I was on the Health Committee when we had that debate and we went to Dublin to look at what had happened in Ireland. A guy there tried to get publicity by saying, “I’m going to be smoking in this pub tonight. Will you come down and get me?” However, there were very few problems with enforcement and the same is true of us now. We have not seen all the details, but, as far as I am concerned, the provision is a further step towards protecting young people and future generations from premature death as a result of ill health, and we should support that.

[Mr Charles Walker]

My concern about the Lords amendment is that we are in danger of criminalising otherwise very loving parents. We should guard against that. It would be appalling if people who have been good parents in every other way found themselves being criminalised as a result of smoking in a car when their children were present.

I hear the argument about seat belts and it is perfectly and entirely reasonable for the Government to set the terms of their use on the road. If the Government decide that someone who wants to drive on a road has to wear a seat belt, that is highly reasonable. I suggest that, if the Government really are determined to press ahead with banning smoking in cars, that is exactly what they should do: they should ban the consumption of alcohol in cars by any person of any age and ban smoking in cars by any person of any age. That would be a much more honest approach, because, as I have said, if we go down this road we will be criminalising hundreds of thousands of parents. Will a repeat offender—someone who has been penalised three or four times—have their children taken into care because they are deemed to be an abusive parent?

There is an enormous degree of hypocrisy in this House. I am pleased to say that I am a teetotal non-smoker. There are many people in this place who want to ban smoking because they think it is not done by very nice people, but they are much more relaxed about alcohol because of their own habits. If Members are genuinely concerned about the welfare of children, they need to realise that alcohol is the problem, not tobacco. Hundreds of thousands of children have their lives blighted by alcoholic parents and the problems associated with alcohol, yet we never talk about that in this House, because some Members think, “We, as nice people, drink.” I am extremely concerned about the direction of travel.

My final point—I know that others want to speak—is that we will drive another wedge between the police and those they are policing if we implement this provision. It is nonsense. We will expect the police to intervene and that will further widen the gap between them and those they are policing. That should be avoided and we should be very careful about widening that gap.

[Ian Paisley]

Like a number of Members, I am deeply concerned that this provision means that Parliament will slowly but surely become a farce. If Parliament wants to start legislating on issues for reasons of good public relations, this provision is a good idea. However, if we peel it back and look at the evidence, we will see that it is not essential.

We should take time to reflect on the evidence in favour of the Lords amendments. On legislating to prevent people from smoking in cars when children are present, let us be clear that the law, under rule 148 of The Highway Code, currently prevents a driver from smoking in any vehicle. He or she should not smoke in any vehicle when driving, so Lords amendment 125 is about the behaviour of passengers and not necessarily that of the driver. That will make it even more difficult for the enforcer—the police officer—to determine the actions and age of those smoking in a vehicle. We should be in the business of making good, sound and solid legislation, and I do not believe that this provision has been properly thought out. It should be taken back to the drawing board and we should consider who the passenger is and who the provision will affect.

The issue of enforcement is utterly critical, because the police are already not properly resourced to do the job they are currently asked to do in combating real criminals. If we set up another criminal class in the community, we will have to ask the police to go after them. Some police officers will take great joy in going after a soft-touch conviction, but that is missing the point and we have to recognise that the police would not have sufficient resources to tackle the issue.

The crux of the matter is: how many people actually engage in smoking in a vehicle when there is a child present? All we have heard from Members on both Front Benches is a guesstimate, not facts. When New Zealand carried out a similar action, it found that 0.13% of people smoked in a vehicle with a child present. We are asking this nation to legislate on something that is an incredibly minor problem.